As part of the Innovation Team on CDI’s Health Project, Lisa Schomerus (left) is one of the volunteers researching the current healthcare system in Dar es Salaam, and engaging with members of the community to ascertain how CDI can best meet the demands of a growing population. Here, she highlights the importance of how, in seeking to improve the accessibility and affordability of healthcare products, the Health Project must carefully consider the balance between the current healthcare system and the habits and needs of the community.
Vingunguti is an informal settlement in Dar es Salaam, home to more than 100,000 inhabitants. Walking around the streets, the population demographic is dominated by young children, and the main streets are busy with street vendors and people running errands.
Conversing with local residents and healthcare providers the need to facilitate change for the healthcare provision in Vingunguti becomes clearer. Government publications are somewhat limited in providing a full picture of the problems faced by the community on a day-to-day basis. Our role for the past two weeks, therefore, has been to bridge this gap between what the healthcare delivery system should look like in practice, and what, in reality, we have found to be the current national standards.
So far, the main problems we have identified revolve around the poor availability of health-promoting products and services that are affordable. For instance, locals often bypass the healthcare system when they are ill due to the expense of diagnosis, and instead obtain medication from street vendors, without the need of a prescription. These street vendors are usually unqualified members of the public and sell items such as electronic accessories and peanut snacks along with these drugs.
Added to this, many patients tend to visit health centres only at the latter stages of a disease when other treatments – including traditional practices or consultations with witch doctors – have failed. Moreover, these health centres and other healthcare providers are overflowing with capacity; even if the typical habits of the community were to change, the provision would struggle to accommodate them.
Yet, as a team, it is the community spirit and cohesion of Vingunguti that has struck us most. It is this which will lend itself as indispensable if we are, in cooperation with the locals, to make a sustainable impact on the healthcare system.
Last year, the Health Project saw the implementation of Afya Yetu, a business model which looks to sell affordable healthcare products via under-utilized healthcare workers (whose role it is to educate and advise residents on health matters). Whilst there are a lot of strengths to this model, we are looking to expand a product-range that better meets the demands of the community.
Over the last two weeks, therefore, we have carried out two major pieces of primary research. Firstly, we approached the hospitals, dispensaries, pharmacies and health centres around Vingunguti to understand better the systems in place and the demographic of the population who use their services. Secondly, we have been conducting surveys in collaboration with the WaSH Project to assess the health-related habits and knowledge of the Vingunguti residents. As we now begin the process of evaluating our findings, we hope to establish the impact of the CDI-implemented latrine networks, which serve approximately 450 people, and to what extent this has improved the standards of sanitation in the community.
Adjusting the Afya Yetu model to better improve health outcomes in Vingunguti – and for communities like Vingunguti, in the future – will not be straightforward. For one thing, each community is unique and uniquely challenging. In addition, the role of Afya Yetu in developing better health outcomes is nuanced, and can only be informed by research and experience. Continuing to engage with both the pre-existing healthcare systems in Dar es Salaam as well as community members themselves is one way of achieving this. It is through maintaining this dual communication that we hope to bridge the current gap between the established structures of healthcare and the reality of daily life in the informal settlements of Dar es Salaam.